Encefalitis granulomatosa amebaina causada por balamuthia mandrillaris. Presentación de cuatro casos en pediatría / Balamutia amebis granulomatous encephalitis

Las amebas de vida libre comprenden los géneros Naegleria,Acanthamoeba y Balamuthia,que se distribuyen en la naturaleza y pueden causar infeccíon en el sistema nervioso central en niños y adultos.La variedad balamuthia mandrillaris produce una encefalitis granulomatosa amebiana(EGA)de evolución crónica y que afecta a inmunosuprimidos.Se decriben 4 pacientes de edad pediátrica que presentaron esta enfermedad.Todos ellos eran inmunocompetentes.Solo dos de los cuatro niños presentaron lesiones en la cara,que se corresponde con el modo de contagio más frecuente por inmersión en aguas contaminadas.Uno de los niños inició el cuadro clínico con osteomielitis crónica.La evolución en nuestros pacientes fue aguda,con grave compromiso neurológico.No existieron datos significativos o patognomónicos en los exámenes de L.C.R e imágenes de TAC y RM.El diagnóstico se realizó por biopsia de una lesión cerebral,confirmado por inmunofluorescencia.Todos los niños fallecieron a pesar de recibir diversos esquemas terapeúticos.Conclusión:se sugiere considerar la infección por ameba de vida libre en el diagnóstico diferencial de un niño que presenta un cuadro de encefalitis aguda,independiente de si es o no inmunocomprometido

ASCUS: comparative follow-up results related to previous SIL diagnosis.

The clinical significance of ASCUS (atypical squamous cells of undetermined significance) remains undetermined. In a variety of cases, it is possible to identify an underlying neoplastic squamous lesion. With the aim of establishing some rationale basis for management, we have evaluated the history and the follow-up of 137 woman diagnosed with ASCUS. These woman were distributed into two groups, with or without history of SIL (30 and 107 woman, respectively); 38 woman did not come to the control. In general, the rate was 30.3% for low grade SIL (squamous intraepithelial lesions) and 6.1% for high grade SIL. In both groups the rate of low and high grade SIL was similar. In our opinion, women that are diagnosed with ASCUS must be submitted to colposcopic exams independently of their history.

Myocardial revascularization in women.

To compare the results of coronary artery bypass in women and men, we reviewed our experience from January 1976 through June 1989. During this period, 170 women with coronary artery disease but with no other cardiac abnormalities underwent coronary artery bypass. We compared this group with a group of 150 men, matching them according to age, presence of angina, extent of disease, and surgical treatment. Preoperative clinical features, surgical data, and early and late results were analyzed. The operative mortality was similar between groups (2.9% for women vs 2.6% for men). The women, however, were more frequently overweight (54% vs 15%; p <0.001) and more often had the following: diabetes mellitus (34% vs 20%; p <0.01), a coronary artery diameter of <1.8 mm (64% vs 29%; p <0.001), poor saphenous vein quality (50% vs 16%; p <0.001), and incomplete revascularization (20% vs 4%; p <0.001). After a mean follow-up of 6 years, the women also had a higher incidence of recent-onset myocardial infarction (31% vs 12%; p <0.001) and a greater tendency to be symptomatic (48% vs 19%; p <0.001). The 12-year cumulative survival rates were similar in both groups (76.2% for women vs 77.1% for men). According to logistic regression analysis of the significantly different variables, the only independent determinants of postoperative asymptomatic status were satisfactory coronary artery caliber, good saphenous vein quality, and complete revascularization. We conclude that poorer functional results after coronary artery bypass surgery in women may be caused by a poorer quality of revascularization, which in turn is a result of smaller coronary artery diameter, worse distal runoff, and less satisfactory vein quality.

[Clinical trial by perexiline maleate in treatment of angina pectoris (author's transl)]. / Esperienza clinica con perexiline maleato nel trattamento dell'angina pectoris

A controlled double blind clinical trial has been conducted in 16 patients with "angina pectoris" in order to investigate the effect of Perexiline maleate as compared with prenilamine. Perexiline at the dose of 400 mg/die and prenilamine at the dose of 120 mg/die have been administered over a period of 4 weeks each. Between these periods placebo has been administered for two weeks. The number of attacks of angina and the number of tablets of nitroglycerine used per week by the patient during each period has been used for the evaluation. Furthermore ECG at rest and after exercise has been performed every two weeks. Our results statistically evaluated show a definite antianginal effect of Perexiline. According to our experience Perexiline should be considered the drug of choise in the treatment of angina complicated by bradicardia, left ventricular failure, bronchospasm, and in angina unresponsive to other drugs.